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Nursing Facility Evaluation for Acute Change in Condition

South Carolina rates for HCPCS G9685

Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. This service is for a demonstration project

Rates data updated October 2026.

How much does Nursing Facility Evaluation for Acute Change in Condition cost?

$191

Typical physician fee. In South Carolina, October 2026.

Insurers have agreed to pay about $191 for this service. Most negotiated rates run $158 to $209.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $174 · 10th to 90th $158 to $513Professionalmedian $191 · 10th to 90th $158 to $251
$200$500facility $174professional $191

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$158.49
Median
$158.49
Typical High
$158.49
Aetna
Setting
Professional
Modifier
None
Typical Low
$158.49
Median
$158.49
Typical High
$190.55
BCBS South Carolina
Setting
Professional
Modifier
None
Typical Low
$223.87
Median
$223.87
Typical High
$234.42
BCBS South Carolina
Setting
Professional
Modifier
29
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
Cigna
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Medcost
Setting
Facility
Modifier
None
Typical Low
$158.49
Median
$186.21
Typical High
$512.86
Medcost
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$194.98
Molina
Setting
Professional
Modifier
None
Typical Low
$169.82
Median
$190.55
Typical High
$208.93
United
Setting
Professional
Modifier
None
Typical Low
$177.83
Median
$234.42
Typical High
$398.11

Where South Carolina sits

The same service costs 4.7 times more in Alaska than in Alabama. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

South Carolina· 38th of 51

$191

AK $708AL $151

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.